08040146CITY OF CUPERTINOf
BUILDING DIVISIONPERMIT.`
BUILDING ADDRESS:
PERMIT NO.
20819 GARDEN GATE DR
TBD — TO BE DETERMINED
08040146
OWNER'S NAME:
PERMIT ISSUE DATE
SANITARY NO, CONTROL NO.
ARCHTTECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACInDWS DECLARATION
licensed Chapter 9
Job Descri tion
p
1 beeby affirm that 1 am under provisions of (commencing
withl Lion 7000) of Division 3oftheBusiness and profession; Code, and myficenseis
SFDWL-2 STORY 4,121' ATACHED GARAGE 712'
in full torte sad set'�p
LleenacCiau LJc.fr
7/25/8 GENL CONTR, SOLVO BUILDING WORKSHOP INC PD
Date tractor 15—,Vf Yb Ag/14
Crs DEcLAxwnON ��
FOR BUS LIC 7/25/8
1 understand my plana shall be used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby afrurm that I am exempt from the Contractor's License Ljw for the
Following mason (Section 7031.5, Business and Professions Code: Any city m county
Which requires a permit to contract, alter. improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit res file a signed statement
that he is licensed pursuant to the provisions of the Contractor's LJcense Lsw (Chapter9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$400000
that he is exempt tbmdmm and the basis for the alleged exemption. Any violation of
Number
O
Occupancy �' Pe
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty or
not more than five hundred dollars (S500).
32630046 .``UUum
❑ L as owner of the property, or MY employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec- 7014, Business
and Professions Cade: The Contractors License w-'�» Lew does not apply m ,n owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements ase nes inbnded or offered forsale. If,
however, the, building or improvement is sold within one year of completion, the owner-
builder will have the burden of proving that he did not build or improve for purpose of
❑ L as owner of the property. am exclusively contracting with Bowed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li-
cense Law does not apply to in owner of property .who builds or improves thereon, and
who contracts for such projects with a contracior(s) licensed pursuant to the Comnctoes
License Law.
-
❑ 1 am exempt under Sec , B & P C for this reason
Owner Due
WORKER'S COMPENSATION DWC7_ TION
hereby affirm tinder penalty of perjury one of the following declaration
VI haft and will maintain a Certificate or Consent m self-insure far Workers Camper-
VII
on, as provided for by Section 3700 of the Libor Code, for the performance of the
work for which this permit is issued
❑ I have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued
My Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CEITI7JICATE OFF—EXEMPTION FROM WORKERS
COMPENSA71ONINSURANCE
,
(This section need not be completed if the permit Is foram hundred dollars (5100)
Of las.)
1 certify that in the performance of the work for which this permit is issued 1 shall not
employ any person in any manner so as to be t t Worker' Compensation
Lava of California. Date
Applinam —
NOTICE TO APPLJCANI.", Cedifica of Excmption. you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked
CONSTRUCTION LF-LADING AGENCY
I hereby affirm that them is a construction lending agency for the performance of
the work for which this permit Is issued (Sec. 3097, Civ. C-)
Lenders Name
Lander's Address
,
I certify that I have read this application and swe that the above information is
correct I agme to comply with all city and county ordinances and sate laws relating to
building construction. and hereby authorize representatives of this city to enter upon the
ah.1mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. costa and expenses which may in any way accrue agalast said City
in consequence of the granting of this permit
it
APPLICANT UNDERSTANDS AND WILL COMPLY WITH A NON OINT
Issued by: Date !/ �)
SOURCE
r14Re-roofs
Type of Roof
Signature of A fcant/Con Date
HAZARDDfjS MATERIALS DISCLOSU
Will the applicant or future building occupant atom or handle hazardous material
as Wined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, section 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
[3 Yes o
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment a devices which
emit hazardous sir contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Dila ict7
❑ Yes o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 aril 25534.1 understand that if the building
does riot currently have a tenant. that it is my responsibility m no y the Occupant of the
requirements ofaCenif r
Signature of Applicant Date
p
All roof coverings to be Class 'J'' or better
Ownner Date '
or ruid6e.15d agent